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How to Get Pre-Authorization. Search for your drug on the TRICARE Formulary Search Tool. Download and print the form for your drug. Give the form to your provider to complete and send back to Express Scripts. Instructions are on the form.
You'll submit forms to Military Medical Support Office (MMSO) at Defense Health Agency-Great Lakes to do the following: Request pre-authorization for civilian medical care or surgical care. Verify eligibility for medical care. Submit a formal appeal.
A pre-authorization is when your care is approved by your regional contractor before you go to your appointment. If you are being referred, your provider will get you a referral and pre-authorization at the same time.
Use our Prior Authorization, Referral and Benefit tool. Is it an ancillary service, such as diagnostic radiology or lab tests? Our Ancillary Services Approval Requirements tool tells you if you need an approval from HNFS.
Certain services (e.g., Applied Behavior Analysis (ABA), inpatient admissions, some behavioral health services, adjunctive dental care, home health services, etc.) require prior authorization. You can get care from any TRICARE-authorized provider, network or non-network.
How do I request a new prior authorization or referral? TRICARE requires a provider, typically your primary care manager or family doctor, to submit prior authorization and referral requests. Please contact your provider and have him or her submit your request.
TRICARE approves coverage for LDTs to inform and support clinical decision making in the care of our beneficiaries. Prior authorization requirements. Prior authorization is required for all LDTs except for Cystic Fibrosis (CF) testing.
Use the Prior Authorization, Referral and Benefit Tool to find out if a service requires a Health Net referral or prior authorization..
You can use the TRICARE Formulary Search Tool to check the cost of a medication, its formulary status, prior authorization requirements, and any forms needed to process a patient’s prescription including medical necessity forms.
To find out if your prescription needs pre-authorization, you can go to the TRICARE Formulary Search Tool. Enter the name of your prescription drug in the search tool. If the drug requires pre-authorization, a form will be available for you to download by clicking “Coverage rules apply.” Otherwise, the form won’t appear.